Modes of death, frequency of a healed or an acute myocardial infarct (MI) or both, numbers of major epicardial coronary arteries severely narrowed by atherosclerotic plaque, and heart weight were studied at necropsy in 889 patients aged 30 years of age or older with fatal atherosclerotic coronary artery disease (CAD). No patient had had a coronary bypass operation or coronary angioplasty. The 889 patients were divided into 4 major groups and each major group was divided into 2 subgroups: 1) acute MI without (306 patients) and with (119 patients) a healed MI; 2) sudden out-of-hospital death without (121 patients) and with (118 patients) a healed MI; 3) chronic congestive heart failure (CHF) with a healed MI without (137 patients) and with (33 patients) a left ventricular aneurysm; and 4) sudden in-hospital death without (20 patients) or with (35 patients) unstable angina pectoris. The mean age of the 687 men (77%) was 60 + 11 years. and of the 202 women (23%), 68 + 13 years (p=.0001). Of the patients studied, 53% had systemic hypertension, 39% angina pectoris, and 33% diabetes mellitus. Of the 880 patients, 415 (48%) had 1 or more grossly visible left ventricular scars. Over half (51%) of the 889 patients had 3 or 4 (includes left main) major epicardial coronary arteries narrowed >75% in cross-sectional area by atherosclerotic plaque. The mean heart weight in the men was 505 + 110 g, and in the 202 women, 427 + 94 & (normal in men <400 g; in women, <350 g) (P=.0001), and only 20% of the patients had a heart of normal weight.